Basic Physics of Ultrasound

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 Fundamentals of Ultrasound

To learn how to use ultrasound effectively, it is useful to understand

the basic physics and its clinical concept. Ultrasound imaging system
use a transducer also called an ultrasound probe to send sound wave
into the patient's body.

These sound wave bounce off different tissues within the body, and
return to transducer.

The return sound waves or echoes are processed by an ultrasound

engine to produce a black and a white image of the organ.

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Ultrasound is a series of tiny mechanical pressure waves propagating
through the body. These sound waves are generated, transmitted and
received by ultrasound transducer.

Now let us see how this works? Let transducer contains several
piezoelectric elements that are excited by an electric current.

An electric current applied to a piezoelectric element causes the

element to expand and contract creating a pressure wave. These
pressure waves propagate through tissue in the body. The echo is
reflected from the tissue returned to the transducer elements and are
processed to create ultrasound images

Ultrasound Image Formation

An ultrasound is a cross-section inside the patient that is formed line
by line in front of the transducer.

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Here we see how a typical image of the right kidney would appear on
screen as the user positions, the transducer at the different angles to
produce images.

An electric current is applied to the elements in the transducer. This

generates a transmitted pulse or sound wave propagating through the
patient. The sound travels rapidly through human tissue at
approximately one thousand five hundred and forty meters per second.

As sound wave reaches internal structures reflected waves are sent

back to the transducer surface. The waves are processed to generate
black-and-white images since sound travels back and forth at a known
speed. The system is able to interpret the signal and display structure
at their exact location on the screen.

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Shallow structures which reflect first will be displaced at the top of the
image echoes from deeper structures that take longer to return and are
displaced at the bottom of the image. This processing is done rapidly
enough to display moving image in real time.

Understanding sound beam interactions (including attenuation, reflections

and the effects of frequency):

Attenuation With ultrasound, the major source of the sound wave

attenuation in soft tissue is absorption which is the conversion of
acoustic energy into heat. This results in the ultrasound wave becoming
weaker over distance.

Deeper structures can be more difficult to see with ultrasound as the

signal attenuates. Most ultrasound systems compensate for weaker
deep signals by increasing the time gain compensation otherwise known
as TGC or gain at deeper levels. Increasing the TGC or gain brightens
deeper structure to improve visibility.

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Reflection occurs when a sound wave encounters a boundary between
two different media such as between tissue and bone. Some of the wave
bounces back toward the source of the echo. The reflected angle
incidence is identical to the transmitted angle of the incidence.

Structures such as a bone are strong reflectors which means that most
of the incoming wave is reflected by the structure, in this acoustic
shadow will be created.

Scatter occurs when ultrasound waves encounter a medium with a non-

homogenous surface.

A portion of the sound wave is scattered in random directions. The

sequence of scatter is known as speckle which produces the grainy
appearance in an ultrasound image.

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For sound to travel through the body, the medium must be acoustically
coupled, since ultrasound is reflected by air.

We need to use gel and there has to be proper contact between the
transducer and the patient, when air is trapped between the transducer
face and the skin, it reflects sound waves and creates shadowing.

Sound frequencies:
A good example to demonstrate the concept of sound frequencies is
listening to loud music played in the home next door. The bass or low
frequency is often heard through the wall. Higher frequencies are often
attenuated or absorbed by the walls home.

One cycle of a sound is composed a complete positive and negative

pressure change. The distance travel during one cycle is called the
wavelength. The frequency of the wave is measured in cycle per
second or Hertz.

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Audible ranges of wavelengths hear by humans are between 16–20000HZ.
The range is higher 20 kHz are not heard by humans and are
considered ultrasound.

In the case of typical ultrasound imaging, the frequency range is

between 1 and 20 MHz, smaller piezoelectric elements vibrating
relatively faster, generates higher frequency, larger piezoelectric
elements vibrating relatively slower will create lower frequencies.

Several parameters affect the clarity of an ultrasound image, one of

them is frequency.

Lower frequencies are less attenuated and provide better penetration,

which is good for deeper structures. Higher frequencies provide a
better resolution for shallow structures. For optimal imaging, it is
critical to select the transducer with the right frequency, for the
anatomy being examined

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Let us review some highlights about the physics of ultrasound.
Ultrasound images formed by listening to echoes from structures,
reflecting a generated ultrasound beam or sound wave.

As sound gets attenuated while going through tissue, the signal gets
weaker in deeper structures. Ultrasound systems amplify these weaker
signals to brighten the image for better visibility.

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Higher frequencies provide higher resolution for shallow anatomy,
lower frequency enable imaging deeper inside the patient.

Absorption may prevent imaging behind solid structures, reflection may

prevent behind solid structures or air.

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Fundamentals of Ultrasound (Equipment & Usage)

Let us discuss the three most popular of the transducers. The active
elements of a curved array or convex array transducer are arranged in
a curved line. This creates a sector shape image and the large face or
aperture produced a wide near field image.

You will a broad view near the transducer surface and deeper within the
body, this makes curved array transducers popular for scanning the
abdomen or foetus, where a large field of a view is important.

A phased array transducer element arranged in a row and the face is

fairly small. The elements are steered electronically to produce a pie

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shaped image. The near-field image quality is typically not as good as
convex array because there are few elements. The smaller footprint is
able to access smaller imaging windows such as cardiac images
between ribs.

The active elements in a linear array are arranged in straight line and
typically not steered. This result in evenly spaced beams, and the best
resolution.

Higher frequencies are usually used in linear transducers, which work

well, for vascular and superficial soft tissue studies.

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Scanning Planes:
Let us talk about scanning planes. Before we discuss the for scanning
planes, let us go over transducer orientation. Most transducers have a
small pump mark or indicator at one end of the transducer. This
indicator corresponds to the first element of the transducer and will a
matching indication marker on the left side of the ultrasound image.

If the transducer is placed on the anterior of the patient's body, with the
mark directly toward the patient's head.

Anatomy toward the head will display on the viewer's left turning the
transducer 90 degrees counterclockwise will result in the transverse
image with anatomy on the patient's right displayed on the viewer's left.

The first scanning plane we will discuss is the transverse plane.

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The transverse scanning plane runs parallel to the ground, separating
superior from inferior or the patient's head from the patient's feet.

Next we look at the longitudinal or sagittal plane. The sagittal plane is

oriented perpendicular to the ground separating the patient's left from

the patient's right.

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The next plane we will look at is the coronal plane.

The coronal plane separates the patient's interior from posterior or the
front from the back.

The last plane we will discuss is the oblique plane.

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The oblique plane is oriented neither parallel to nor at right angles from
the other planes. This is used to image structures that are positioned at
angels inconsistent with the other planes.

Imagine Modes:

There are three imaging modes which are B mode M mode and Doppler.
B mode or brightness mode is the most commonly used mode in
ultrasound.

B mode provides real-time structural information using different

shades of gray in a two-dimensional image. The brightness of the
displayed structure is also known echogenicity.

Strong return signals with high amplitude will display increased

brightness or echogenicity.
M mode stands for motion mode. It captures the returning echoes along
one line of the real-time image and displays them over time axis.

M mode is used to capture and quantify motion information such as

cardiac motion or fetal heart beat.

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The M mode image can be measured to quantify motion over time. An
example of this would be beats per minute.

Doppler looks at the frequency shift caused by sound waves interacting

with moving target such as red blood cells in vessel.

The ultrasound system expects a signal sent to fix location to return to

the transducer in a specified amount of time.

If the target is a specific location in vessel with moving blood, the

reflected sound waves will return earlier or later depending on the
direction of moving blood flow.
Color and pulsed wave Doppler are used to visualize and quantify blood
flow information. Pulsed wave Doppler samples a specific spots in the
vessel, and accurately displays the moving blood

Color Doppler shows the approximate speed and direction of the blood
flow inside the vessel.

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A red color is typically used to displays blood directed toward the
transducer and the blue color is used to identify blood away from the

transducer. A spectrum is used to measure the velocity of blood flow.

Another method is used to display blood flow is power Doppler.

In this case, the ultrasound system looks at the strength or amplitude of

retuning signal. This method is more sensitive and useful to display
slow moving blood.

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Review:

Let us review transducer types and imaging modes. The most common
transducers types are curve array, phase array and linear array.

 Curved array produces a large field of view including the near-

field and far field.
 Phase array offer a small face to get between the ribs.
 Linear array provides high resolution imaging and a large near-
field image.

Different scanning planes are used to visualize patient an anatomy

depending on the position and orientation of the anatomy being scanned.
The scanning planes used are transverse, sagittal, coronal and oblique.

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The various imaging modes we were discussed are

 B mode or brightness mode is the most common ultrasound

imaging mode.
 M mode or motion mode quantifies over time.
 Doppler mode is used to evaluate velocity of blood flow.

 Color Doppler mode assigns color to blood flow based on the flow
direction toward or away from the transducer.
 Power Doppler assigns a color to the blood flow based on the
strength or amplitude of the returning signal.

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Ultrasound Training Liver
This videos demonstrate how to setup and preform an ultrasound of the
liver. Equipment required includes the following:

1. Ultrasound machine
2. A selection of transducers.
3. An examination table.
4. Positioning aids such as wedge, sponges or pillows.
5. A chair.
6. Acoustic gel.
7. Examination gloves.
8. Bed linen, and towels.
9. Stenographer's work sheet.

Ask the patient to lie supine on the examination table, and make them
convertible with the use of the pillows or wedges positioned as required
put on gloves exposed the patient's abdomen and apply gel to the right
subcostal region from epigastrium to the flank.

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Select the transducer of appropriate frequency and conform the correct
transducer selection and preset on the ultrasound machine.

Perform a survey of the abdomen and make any necessary adjustment

to the machine setting to maximize the image quality.

Once the survey is complete, begin the liver scan. The most useful
positions for liver imaging include the right subcostal and intercostal
approaches, ask the patient to take in the deep breath and hold it. This
displaces the liver downwards, and improves the acoustic window,

obtained the longitudinal images of the liver with the patient in the
supine position taking a note of any abnormalities.

A series of six longitudinal images are recorded by making small

incremental movements, starting from the left of the midline, moving

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along right subcostal margin the inferior border of the right lob of the
liver.

These images should display as the following:

1. The left lobe of the liver. 8. The gallbladder

2. The left lobe of the liver diaphragm. 9. The portal vein.
3. The caudate lobe. 10. The right lobe of the liver.
4. The right lobe of the liver. 11. The right lobe of the liver.
5 The inferior vena cava. 12. The right kidney
6. The right lobe of the liver. 13. The diaphragm.
7. The main lobe our Fisher.

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Manipulate the transducer until a suitable image of the liver is obtained.
If the suitable image is not obtained. a left lateral decubitus patient
position and/or intercostal transducer approach, may also be utilized.
When a suitable image is obtained freeze the image annotate the scan
plane patient position and structures identified.

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